[Major resection in severe hepatic trauma. Technical indications and clinical considerations in a case of personal...

Before the Second World War overall mortality from liver injuries was 60%. The extraordinary progresses made in elective hepatic surgery, backed by an increasingly detailed physiopathological knowledge and by progress in anesthesia and reanimation techniques, have had a positive effect also on traumatological liver surgery bringing mortality rates dawn to between 10% and 20%. However, in spite of this reassuring success, mortality from liver injury still remains unacceptably high for the most severe lesions on the "Calne scale", in particular 50-60% for 4th degree lesions. A review of the literature regarding this group of patients indicates hemorrhagic shock as being the prime cause of mortality: extensive lobar disintegration associated with severe vascular disinsertion involving the suprahepatic-caval crossroads are responsible for the patient's death in 50% of cases. Associated intra- or extra-abdominal lesions, which are often commonplace, make a decisive contribution to raising the mortality rate for 4th degree lesions. Lastly, the high number of possible postoperative complications contributes to the severity of prognosis in this group of patients. The analysis of a case of severe hepatic injury (4th degree according to Calne's and Lenriot's classifications) with a favourable outcome prompts the author to make a number of clinical and surgical observations, and to conclude that emergency hepatic resection still continues to be a rare indication reserved for cases of absolute necessity for which there is no other possible therapy.